0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Ideas and Opinions |

Safety of the Blood Supply in the United States: Opportunities and Controversies

James P. AuBuchon, MD; John D. Birkmeyer, MD; and Michael P. Busch, MD, PhD
[+] Article and Author Information

From Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Veterans Affairs Medical Center, White River Junction, Vermont; and University of California, San Francisco, California. Grant Support: In part by National Heart, Lung, and Blood Institute contract NO1-HB-47114 (Retrovirus Epidemiology Donor Study) (Dr. Busch). Requests for Reprints: James P. AuBuchon, MD, Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. Current Author Addresses: Dr. AuBuchon: Department of Pathology and Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(10):904-909. doi:10.7326/0003-4819-127-10-199711150-00009
Text Size: A A A

The risk for viral transmission by transfusion has been reduced dramatically through improved techniques for selecting and testing blood donors.Initiatives to further improve the safety of the blood supply, including more stringent donor qualifications, additional testing for infectious disease markers, viral inactivation processes, and refinement of transfusion decisions, are possible. However, because the risk for viral transmission by allogeneic transfusion is already low, additional measures will have limited yield and poor cost-effectiveness. Furthermore, unexpected side effects of some of these “improvements” may reduce the safety of the blood supply by introducing new risks. Cost-effectiveness analyses of blood safety initiatives have highlighted such successes as the introduction of virus-specific assays for screening donated blood and have identified other interventions that have poor cost-effectiveness estimates. They have also quantitated the threshold level at which the risks of an intervention outweigh its benefits. These analyses have had little effect on decisions about blood safety, possibly because of overwhelming fear of AIDS and difficulties in applying cost-effectiveness estimates to a politically and emotionally charged issue. Future interventions for improving blood supply safety must be evaluated thoroughly and chosen carefully so that the intended goals are met. Communication with the public should be undertaken so that the public understands that some of the desired measures may result in inefficient allocation of health care resources.

Figures

Grahic Jump Location
Figure 1.
Decrease in per-unit risk for transmission of hepatitis B virus (broken line), hepatitis C virus (dotted line), and HIV (solid line) by blood transfusion in the United States.[4]

The arrow shows the current risk for death from acute hemolysis for comparison.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Comparison of cost-effectiveness of transfusion safety interventions (striped bars) and other medical practices (white bars)[27-31]

. ALT = alanine aminotransferase; anti-HCV = antibody to hepatitis C virus; HCV = hepatitis C virus.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)